& COVID-19

A TOOLKIT FOR DOULAS What's LIST OF KEY CONCEPTS - Facts about COVID-19 Included in - How doulas can continue to support their clients - Do's - Impacts to doulas this toolkit? - Tips for attending births and postpartum visits - How to protect YOURSELF - Additional resources and informative links

Facts about COVID-19 What is COVID-19? Symptons of COVID-19 COVID-19 is an illness caused by Symptoms of a coronavirus. Coronaviruses are coronaviruses may be very common in and animals. mild or more serious, such as: COVID-19 is a respiratory illness

that can spread easily from Fever person to person. Symptoms Cough range from mild to severe and Difficulty breathing and may take up to 14 days to appear shortness of breath after exposure to the virus.

How does COVID-19 Spread? Coronaviruses are most commonly spread from an infected person through: respiratory droplets when you cough or sneeze, close personal contact such as touching or shaking hands, and/or touching something with the virus on it then touching your eyes, nose or mouth before washing your hands. These viruses are not known to spread through ventilation systems or through water. How doulas can support their clients STAY LOCALLY UPDATED Keep abreast of the local situation in your area and specifically what your public health department is suggesting/recommending. Use only reputable information sources such as the CDC. TALK TO YOUR CLIENTS Use a non-fear inducing approach. Make this a normal part of the DISCUSS THE WHAT-IFS conversation, and be mindful to not invoke panic. Be gentle. This is Help your clients work through the various scenarios a stressful situation, especially for those welcoming a new baby. that may occur, if that is helpful to them, especially if Understand you may need to do prenatals and postpartums there is a possibility that your presence may be remotely via video conferencing apps such as Skype, Zoom & restricted by hospital policies or quarantine Google Hangouts. recommendations. Discuss what might help them feel Ask clients how they are preparing; use open-ended questions so more prepared and remember that we can only control that you can gauge their level of preparedness and anxiety. what we can control, and sometimes it's best for public Acknowledge that though it may be uncomfortable to discuss, the health to have the restrictions in place. goal is to help people be as safe as possible. Doula Do's WHAT ARE SOME THINGS TO CONSIDER DOING NOW TO PREPARE?

Learn and use appropriate infection Learn about the usage of Ensure you have a reliable and healthy Ensure your contract control protocols, including washing personal protective equipment back-up doula to take over care for an accounts for these type your hands with soap and hot water (PPE) such as: gloves, face masks extended period should the need arise of emergent situations. for 20 seconds or more regularly or shields, and safety glasses. (DONA recommends doulas ALWAYS For already executed and anytime there is visible dirt on Practice social distancing - avoid have reliable back-up support). contracts, speak with them. Clean your hands with alcohol large gatherings, cancel or Understand that once you get to a birth, client about how to you may not be permitted to switch out based sanitizer before going INTO a reschedule events, and put 6 feet account for an room and before LEAVING a room. with a backup doula; be prepared for a emergency and consider of space between yourself and longer labor support experience. adding an addendum to others. your contract.

Help your clients work through the various scenarios that may occur, if that is helpful to them, especially if there is a possibility that your presence may be restricted by hospital policies.

Support clients at home as long as possible before they transfer to

the hospital, then offer remote, virtual support through video conferencing apps such as Skype, Zoom or Google Hangouts. Consider alternative birth place options. Offer additional postpartum support in lieu of birth support. How might this impact doulas?

Much was learned during the SARS outbreak and now hospitals around the globe are better prepared. We are confident that the majority of hospital systems recognize the valuable contribution doulas make in supporting families’ wellbeing and positive birth outcomes. We also recommend doulas reach out to their hospitals proactively to ensure families can rely on their doula’s support during their birth. DONA has prepared a letter that can be sent to hospital administrators proactively.

Scenarios that took place during SARS (2003) included: Limits during Required health labor: screenings: Some hospitals allowed Limits Restrictions on Some hospitals operated only one person during immediately Doulas: as usual, but with labor. Clients often chose postpartum: Some hospitals allowed screening of all visitors as their partner. This one Some hospitals didn’t doulas, but only if they currently recommended support person was not allow any support people hadn’t visited another by the CDC. (2) interchangeable (for during postpartum hospital within a certain example, the partner recovery. time frame prior, or only could not spend one hour allowed one doula and no and alternate with a doula, backup switch-outs. friend, or family member). Best What if I'm not feeling well? If you have any of the symptoms of a illness (mentioned above) use practices a back-up doula and see your local provider (or as directed by your public health department). when Should I use a backup? If you are not well, you should not attend the birth or postpartum working with visits. If your family members are not well, you should also consider utilizing your backup. You might want to consider hosting remote clients meetings via video conferencing apps such as Skype, Zoom or Google Hangouts. Given how new this virus is, we currently have very little How does social distancing play data on how it might affect pregnant people and out in birth and postpartum? newborns. Guidelines from the CDC outline Social distancing is a term applied to certain actions that are taken by Public recommendations for how to support pregnant and Health officials to stop or slow down the spread of a highly contagious . It includes cancelling large group activities, closing schools etc. People can laboring people with Coronavirus.(3) There is currently implement social distancing practices individually in birth and postpartum by no evidence that the virus is spread from to limiting extra visitors, being mindful of avoiding large crowds when they do go out and limiting exposure to anyone who shows symptoms of illness. Doulas can baby in utero, or that it is transmitted in human milk.(4) discuss plans with clients as they prepare for birth and postpartum by relying on the recommendations of public health officials. Avoid giving your own opinions or anecdotal recommendations. Let local, state, and global public officials guide the narrative.

Doula Tips for Birth and Postpartum

UNDERSTAND THAT THINGS MIGHT BE DIFFERENT AND CONSIDER... "HOW WILL SHE REMEMBER THIS?" -PENNY SIMKIN

What to wear: What to bring: What to know: What to remember: Make sure you wear Have lots of snacks and food Hospitals will have various This is an important time for comfortable and easily with you for births. Movement protocols and they may your clients, the most precious washable clothes. Have an around your hospital may be change rapidly, even daily. days for their family. Anxiety additional set of clothes with restricted, including movement Be prepared to be flexible may be high and adrenaline you. Be prepared to wear to the cafeterias. Exchange with the protocols that are levels may interact with labor hospital protective gear over reusable items from your doula being put in place. You may and new parenting. Work your clothing. Have a clean bag with disposable items not be able to switch out diligently to create a loving, set of clothes at your door so instead. Bring extra cash and with a backup doula as peaceful environment despite you can remove your clothes self-care items in case of a usual, or you may have to the stress of it all. before entering back home. longer support experience. switch in/out with the Wear easily washable shoes. Don't forget your washed partner. Patience & grace hands and warm heart! will be of the essence. Why clean hands are so importantant Donning protective gear (putting on) WHAT DOULAS SHOULD KNOW ABOUT PERSONAL PROTECTION

V IDEO RESOURCES:

Please take a moment to

familiarize yourself with hospital infection control practices and

PPE usage with these four video Safer hand washing Doffing protective gear (taking off) resources. Protect YOURSELF & Others!

IMPORTANT REMINDERS FOR OUR DOULAS Healthy individuals are at low risk of severe complications from Coronavirus: Get good, restful sleep Eat a healthy balanced diet Exercise Balance work with rest Practice meditation and other mindfulness and/or spiritual practices for your mental health Boost your immunity and avoid getting sick Implement social distancing as appropriate Protect YOURSELF & Others!

THE BEST WAYS TO PROTECT YOURSELF INCLUDE: Washing your hands often with soap and hot water for at least 20 seconds, especially after blowing your nose, coughing or sneezing; going to the bathroom and before and after eating or preparing food Avoid touching your eyes, nose, and mouth with unwashed hands and at all times when possible Cover your cough or sneeze with a tissue, then throw the tissue in the trash Stay home when you are sick Resources

BUILDING KNOWLEDGE TOGETHER

Resources: #1 - Government of Canada: Know the facts about coronavirus disease (COVID-19) https://www.canada.ca/en/public-health/services/publications/-conditions/know-facts-about-coronavirus- disease-covid-19.html

#2-Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

#3-Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html

#4-Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) & https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html Resources

BUILDING KNOWLEDGE TOGETHER

Additional Resources:

#5 - National Perinatal Association Facebook Page - Coronavirus Informational Social Media Images https://www.facebook.com/pg/NationalPerinatal/photos/?tab=album&album_id=4306810646011735

#6 - Interim Guidance on for a Mother Confirmed or Under Investigation for COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html